Provider Demographics
NPI:1164996062
Name:GARDNER, BARBARA NICOLE (PT DPT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:NICOLE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15439 DAYBREAK LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0946
Mailing Address - Country:US
Mailing Address - Phone:951-256-7568
Mailing Address - Fax:
Practice Address - Street 1:450 W PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3104
Practice Address - Country:US
Practice Address - Phone:661-273-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist